Provider Demographics
NPI:1043520596
Name:WASSERMAN, DANIEL JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5747
Mailing Address - Country:US
Mailing Address - Phone:310-985-6122
Mailing Address - Fax:310-593-4306
Practice Address - Street 1:2116 WILSHIRE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5747
Practice Address - Country:US
Practice Address - Phone:310-985-6122
Practice Address - Fax:310-593-4306
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor